scholarly journals Usefulness of the Modified Clip-with-Line Method for Endoscopic Mucosal Treatment Procedure

2018 ◽  
Vol 27 (3) ◽  
pp. 317-320 ◽  
Author(s):  
Koichi Soga ◽  
Takahito Shimomura ◽  
Toshio Suzuki ◽  
Tesshin Tei ◽  
Tomohiko Usui ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Normal Mucosa ◽  
Submucosal Layer ◽  
Procedure Time ◽  
Treatment Procedure ◽  
Dental Floss ◽  
Line Method ◽  
Submucosal Dissection ◽  
Cutting Line ◽  
Experienced Endoscopists

Endoscopic submucosal dissection (ESD) might be difficult to perform in some cases even for experienced endoscopists. Recently, various traction methods have been introduced to facilitate ESD procedures, such as clip-with-line (CL), external forceps, clip and snare, internal traction, double scope, and magnetic anchor.The traction procedure using the CL method enhances the visibility of the operation field during ESD. The original CL method is performed as follows: the clip with the line (e.g., dental floss) is attached to the edge of the lesion. Traction can be produced by pulling the line gently, thus achieving a sufficient visualization of the submucosal layer to identify an accurate cutting line. Herein, we present a useful modified two-CL method by pulling the appropriate normal mucosa to enhance the visibility of the operation field during ESD procedure. Thus, the traction methods, including our modified CL technique, might reduce the procedure time and complications.

scholarly journals Endoscopic mucosectomy of the normal mucosa facilitates exposure of the submucosal layer at the commencement of colorectal endoscopic submucosal dissection

Endoscopy ◽  
2016 ◽  
Vol 48 (S 01) ◽  
pp. E213-E214
Author(s):  
Jeremie Jacques ◽  
Romain Legros ◽  
Paul Carrier ◽  
Sophie Geyl ◽  
Veronique Loustaud-Ratti ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Normal Mucosa ◽  
Submucosal Layer ◽  
Submucosal Dissection ◽  
Colorectal Endoscopic Submucosal Dissection

PS02.146: LARYNX-PRESERVING SURGERY FOR CERVICAL ESOPHAGEAL CANCER USING INTRAOPERATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION: A CASE REPORT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 162-162
Author(s):  
Yoshiki Taniguchi ◽  
Koji Tanaka ◽  
Yasuhiro Miyazaki ◽  
Tomoki Makino ◽  
Tsuyoshi Takahashi ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Tumor Invasion ◽  
Pathological Examination ◽  
Submucosal Layer ◽  
Cervical Esophageal Cancer ◽  
Submucosal Dissection

Abstract Background We sometimes experience cases of cervical esophageal cancer which requires laryngectomy due to spread of cancer to larynx. We report a case of esophageal cancer resection with preservation of larynx using intraoperative endoscopic submucosal dissection. Methods The patient was a 59-year-old woman who had dysphagia. She had received total gastrectomy with Roux-en-Y reconstruction for gastric cancer in 2001, chemoradiation (61.2Gy) for esophageal cancer in 2008. Argon plasma coagulation (APC) was performed for the carcinoma in situ of cervical esophagus in 2016. This time superficial 0-IIc tumor was observed at the same site of the scar of APC, and a biopsy revealed squamous cell carcinoma. An endoscopic findings revealed two 0-IIc lesions at distance of 18–22 cm, and 32–34 cm from the incisors, and biopsy resulted in a diagnosis of squamous cell carcinoma. Since tumor was close to the esophageal orifice, the tumor invasion to the larynx was suspected. On the other hand, there were no obvious findings of the submucosal layer invasion, and the both tumor were thought to be limited to the epithelium or lamina propria mucosae (EP/LPM). We performed mediastinoscopic and thoracoscopic transhiatal esophagectomy, subcutaneous ileocolic reconstruction. Results After confirming the tumor invasion to the esophageal orifice by chromoendoscopy with 1% Lugol's iodine solution, we dissected the whole circumference of esophagus in submucosal layer just above the tumor by ESD, put an incision outside of esophageal wall, and resected the esophagus. We preserved short length of muscle layer and performed reconstruction with hypopharynx-ileum anastomosis. Pathological examination revealed squamous cell carcinoma, pT1a-EP, ly0, v0, pPM0, pDM0, pIM0, and curative resection was performed. The postoperative course was uneventful. Conclusion There were no reports of successful larynx-preserving surgery for cervical esophageal cancer using intraoperative ESD. When the tumor was limited in the mucosa, esophagectomy with intraoperative ESD may enable larynx preservation even if the tumor invaded to the esophageal orifice. Disclosure All authors have declared no conflicts of interest.

scholarly journals A Novel Technique of Endoscopic Papillectomy with Hybrid Endoscopic Submucosal Dissection for Ampullary Tumors: A Proof-of-Concept Study (with Video)

2020 ◽  
Vol 9 (8) ◽  
pp. 2671
Author(s):  
Naminatsu Takahara ◽  
Yosuke Tsuji ◽  
Yousuke Nakai ◽  
Yukari Suzuki ◽  
Akiyuki Inokuma ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Demographic Data ◽  
Postoperative Bleeding ◽  
Incomplete Resection ◽  
Proof Of Concept ◽  
Procedure Time ◽  
Concept Study ◽  
Submucosal Dissection ◽  
Endoscopic Papillectomy ◽  
Ampullary Tumors

Background: Endoscopic papillectomy (EP) carries a potential risk of procedure-related adverse events and incomplete resection. Since hybrid endoscopic submucosal dissection (ESD) had been established as an alternative option for relatively large and difficult gastrointestinal tumors, we evaluated a novel EP with hybrid ESD (hybrid ESD-EP) for curative safe margin in this proof-of-concept study. Methods: A total of eight cases who underwent hybrid ESD-EP between 2018 and 2020 were identified from our prospectively maintained database. Hybrid ESD-EP involved a (sub)circumferential incision with partial submucosal dissection, and subsequent snare resection of ampullary tumors, which was performed by two endoscopists with expertise in ESD or endoscopic retrograde cholangiopancreatography. Demographic data and clinicopathological outcomes were retrospectively evaluated. Results: En bloc resection was achieved by hybrid ESD-EP in all eight cases, with the median procedure time of 112 (range: 65–170) minutes. The median diameters of the resected specimens and tumors were 18 and 12 mm, respectively. All lateral margins were clear, whereas vertical margin was uncertain in three (38%), resulting in the complete resection rate of 63%. Postoperative bleeding and pancreatitis developed in each one (13%). No tumor recurrence was observed even in those cases with uncertain vertical margin, after a median follow-up of 244 (range, 97–678) days. Conclusions: Hybrid ESD-EP seems to be feasible and promising in ensuring the lateral resection margin. However, further investigations, especially to secure the vertical margin and to shorten the procedure time, should be required.

Tu1969 APPLICATION OF DENTAL FLOSS-ASSISTED SUSPENSION TRACTION IN ENDOSCOPIC SUBMUCOSAL DISSECTION FOR RECTAL NEUROENDOCRINE NEOPLA

2019 ◽  
Vol 89 (6) ◽  
pp. AB635-AB636
Author(s):  
Qiang Shi ◽  
Yunshi Zhong ◽  
Ping-Hong Zhou
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Dental Floss ◽  
Submucosal Dissection

Endoscopic Submucosal Dissection Using EndoTrac, a Novel Traction Device

Digestion ◽  
2020 ◽  
pp. 1-8
Author(s):  
Hidetoshi Kaku ◽  
Takashi Toyonaga ◽  
Shinwa Tanaka ◽  
Hiroshi Takihara ◽  
Shinichi Baba ◽  
...  
Keyword(s):  
High Risk ◽  
Minimally Invasive ◽  
Endoscopic Submucosal Dissection ◽  
Primary Outcome ◽  
Submucosal Layer ◽  
Preparation Time ◽  
Submucosal Dissection ◽  
Traction Device ◽  
Gi Cancers ◽  
Procedural Success

<b><i>Background:</i></b> Endoscopic submucosal dissection (ESD) is recognized as a minimally invasive and curative treatment for superficial gastrointestinal (GI) cancers. However, ESD is still challenging and time-consuming with a high risk of adverse events such as bleeding and perforation. Various traction methods have been explored for maintaining good visualization of the submucosal layer during ESD. We developed a novel traction device (the EndoTrac) which can easily tie the thread and has the ability to change the towing direction. The aim of this study is to evaluate safety and feasibility of ESD using the EndoTrac for GI neoplasms. <b><i>Patients and Methods:</i></b> We retrospectively analyzed 44 patients (45 lesions) with esophageal, gastric, duodenal, and colorectal neoplasms who had undergone ESD using the EndoTrac device between June 2018 and May 2019. Primary outcome measures were preparation time, procedural success using the EndoTrac device, and ease of ability to change towing direction. <b><i>Results:</i></b> Mean preparation time was 2 (2–5) min in esophagus, 3 (1–5) min in stomach, 6 (5–9) min in duodenum, and 4 (2–8) min in colorectum. The procedural success rate was 100% (8/8) in esophagus, 100% (21/21) in stomach, 100% (4/4) in duodenum, and 100% (12/12) in colorectum. The rate of successful towing to both proximal and distal sides was 100% (8/8) in esophagus, 100% (21/21) in stomach, 0% (0/4) in duodenum, and 100% (12/12) in colorectum. <b><i>Conclusions:</i></b> Use of the EndoTrac device appears to be a feasible approach to ESD for GI neoplasms.

scholarly journals Successful traction‐assisted endoscopic submucosal dissection using dental floss and a clip for a huge superficial nonampullary duodenal epithelial tumor with severe fibrosis (with video)

JGH Open ◽  
2018 ◽  
Vol 3 (2) ◽  
pp. 179-181 ◽  
Author(s):  
Tomoaki Tashima ◽  
Kouichi Nonaka ◽  
Hiroki Kurumi ◽  
Yuko Fujii ◽  
Yuki Tanisaka ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Epithelial Tumor ◽  
Dental Floss ◽  
Submucosal Dissection ◽  
Severe Fibrosis

scholarly journals Ex vivo porcine model study on the treatment outcomes of scissor-type knife versus needle-type knife in endoscopic submucosal dissection performed by trainees

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ryoji Ichijima ◽  
Mitsuru Esaki ◽  
Shun Yamakawa ◽  
Yosuke Minoda ◽  
Sho Suzuki ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Treatment Outcomes ◽  
Subgroup Analysis ◽  
Porcine Model ◽  
Ex Vivo ◽  
Procedure Time ◽  
Needle Type ◽  
Submucosal Dissection ◽  
Muscular Injury ◽  
Total Procedure

Abstract Background Endoscopic submucosal dissection (ESD) for gastrointestinal neoplasms can be technically difficult for trainee endoscopists. Presently, there is no consensus for trainees to select the endo-knife type in ESD. Therefore, we conducted a comparison study of treatment outcomes between scissors-type and needle-type knives in ESD performed by trainees in an ex vivo porcine model. Methods This study was conducted on trainee endoscopists who participated in ESD hands-on seminars held in August 2018 and September 2019. A total of 22 trainees from 13 institutions were divided into two groups according to their endoscopic experience. Under expert supervision, each trainee performed two ESDs in porcine models, namely, scissor-type knife (ESD-S) and needle-type knife (ESD-N). The efficacy and safety, including the procedure time and rates of self-completion, en bloc resection, and complications, were compared between ESD-S and ESD-N. In subgroup analysis, we also investigated the predictors associated with the difficulty of ESD for trainees using multivariate logistic regression analysis. Results Eight trainees had an experience of over 1000 endoscopies (senior trainee: S-Trainee), whereas the others had an experience of less than 1000 endoscopies (junior trainee: J-Trainee). Among the S-Trainees, no significant differences were observed in any treatment outcome between ESD-S and ESD-N. Among the J-Trainees, the total procedure and mucosal incision times were significantly shorter in ESD-S than in ESD-N [total procedure time: 16.5 min (range 10.0–31.0) vs. 22.3 min (range 10.0–38.0), P = 0.018; circumferential incision time: 10.0 min (range 6–16) vs. 17.0 min (range 5.0–31.5); P = 0.019]. Regarding complications, muscular injury occurred in two patients during ESD-N performed by J-Trainees; however, no muscular injury occurred during ESD-S. In subgroup analysis, ESD-N was an independent predictive factor of difficult ESD (odds ratio 5.28, 95% confidence interval 1.25–22.30; P = 0.024). Conclusions This study revealed that trainees, particularly those who have experienced less than 1000 endoscopies, should opt for the scissor-type knife to perform ESD.

A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study

Endoscopy ◽  
2020 ◽  
Vol 52 (09) ◽  
pp. 780-785
Author(s):  
Seiichiro Abe ◽  
Yutaka Saito ◽  
Yusaku Tanaka ◽  
Mai Ego ◽  
Fumito Yanagisawa ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Ex Vivo ◽  
Barbed Suture ◽  
Procedure Time ◽  
Closure Rate ◽  
Needle Holder ◽  
Lower Rectum ◽  
Submucosal Dissection ◽  
Mucosal Defect ◽  
Colorectal Endoscopic Submucosal Dissection

Abstract Background This study aimed to demonstrate the feasibility of endoscopic hand-suturing (EHS) and attainability of sustained closure after colorectal endoscopic submucosal dissection (ESD). Methods EHS was defined as uninterrupted endoscopic suturing of the mucosal defect after colorectal ESD using an absorbable barbed suture and a through-the-scope needle holder. Following individual EHS training using an ex vivo porcine colonic model, two experienced endoscopists performed EHS. Repeat colonoscopy was performed on the third or fourth day after ESD to examine the EHS site. The primary end point was the complete EHS closure rate, and secondary end points were sustained closure and post-ESD bleeding rates. Results 11 lesions were included. Median size of the mucosal defect was 38 mm (range 25 – 55 mm) and the lesion characteristics were as follows: lower rectum/upper rectum/ascending colon/cecum = 3/3/2/3, and 0-IIa/0-Is + IIa/others = 5/4/2. EHS was not attempted in two patients owing to difficulty in colonoscope reinsertion after ESD and intraoperative perforation, respectively. EHS was performed for nine lesions, and the complete EHS closure rate was 73 %. Median procedure time for suturing was 56 minutes (range 30 – 120 minutes) and median number of stitches was 8 (range 6 – 12). Sustained closure and post-ESD bleeding rates were 64 % and 9 %, respectively. Conclusions EHS achieved complete and sustained closure in the colorectum. However, EHS is not currently clinically applicable given the long procedure time. Further modifications of the technique and devices are desirable.

Clinical benefit of the multibending endoscope for gastric endoscopic submucosal dissection: a randomized controlled trial

Endoscopy ◽  
2020 ◽  
Author(s):  
Koichi Hamada ◽  
Yoshinori Horikawa ◽  
Yoshiki Shiwa ◽  
Kae Techigawara ◽  
Takayuki Nagahashi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Treatment Guidelines ◽  
Controlled Trial ◽  
Complete Removal ◽  
Muscle Layer ◽  
Gastrointestinal Neoplasms ◽  
Procedure Time ◽  
Operator Experience ◽  
Submucosal Dissection

Abstract Background Endoscopic submucosal dissection (ESD) is a technically difficult and time-consuming procedure. We aimed to investigate the efficacy and safety of ESD using a multibending endoscope to treat superficial gastrointestinal neoplasms. Methods Patients with a single early gastric cancer who met the absolute or expanded indications for ESD according to the Japanese gastric cancer treatment guidelines were enrolled and randomly assigned to undergo ESD using a conventional endoscope (C-ESD) or a multibending endoscope (M-ESD). Randomization was stratified by ESD operator experience and tumor location. The primary outcome was ESD procedure time, calculated as the time from the start of submucosal injection to complete removal of the tumor. Results 60 patients were analyzed (30 C-ESD, 30 M-ESD). The mean (standard deviation [SD]) ESD procedure times for M-ESD and C-ESD were 34.6 (SD 17.2) and 47.2 (SD 26.7) minutes, respectively (P = 0.03). Muscle layer damage occurred significantly less frequently with M-ESD (0.2 [SD 0.7] vs. 0.7 [SD 1.0]; P = 0.04). There were no significant differences between the two techniques in procedure time or damage to muscle layers for tumors located in the lower third of the stomach. Conclusions ESD procedure time was significantly shorter with the multibending endoscope and fewer muscles were damaged. We recommend multibending endoscopy for ESD in the upper and middle thirds of the stomach to reduce procedure time and incidence of complications.

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